Treating Pain Often Involves a Variety of Different Approaches

May 9, 2005

By ADRIENNE MAND LEWIN

Dr. Paul Rumble, a veterinarian from Milford, Conn., knows first hand the challenges of living with chronic pain. Following abdominal surgery for diverticulitis, a buildup of scar tissue left him in agony.

Laparoscopic treatments, which use a tiny camera to guide surgeons' hands, provided temporary relief, but not enough. When the problem came back, Rumble's physician prescribed morphine. The drug worked, but taking it also meant relying on a narcotic to be free of symptoms.

"I was doing great on the morphine, and [the doctor] said, 'OK, that's the end of the story. You're on morphine. You're doing great. Adios,' " Rumble said. "But I said, 'I really don't want to be on morphine for the rest of my life.' "

Enter the pain specialist, who eventually helped Rumble overcome his intense discomfort. Chances are, if your regular doctor runs out of options to treat you for chronic pain, you will be referred to a pain specialist or pain clinic that offers a variety of services -- from drugs to acupuncture and psychological help -- to reduce your symptoms.

But what exactly do these specialists offer? And why should you visit them?

Focusing on Pain Management

Before the field of pain medicine was created, doctors "looked at pain management with blinders on, with one focus," said Dr. Carol A. Warfield, who is the chair of the department of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School.

"If all you have is a hammer, everything starts looking like a nail," she said.

In the 1960s, people in the medical community began to consider pain as a specialty, with the idea of bringing together such fields as internal medicine, chiropractics, surgery, psychology and acupuncture to provide many options for success, Warfield said. The movement was popularized in the 1970s and advanced throughout the years.

Anesthesiologists were in the equation early on because of their experience with easing pain during surgery and with drugs such as narcotics, pain relievers, nerve blocks and other treatments, she said. The American Board of Anesthesiology first added a certification in pain medicine in 1993.

Warfield opened the pain clinic at Harvard Medical School in 1980. It began with her seeing a few patients after a day of surgeries, but it is now one of the biggest clinics of its type in the country, with 100 employees and between 12,000 and 14,000 patients a year.

In addition to physicians who are pain specialists, the clinic offers a full-time psychologist, a neurologist, physical medicine nurses, physical therapists and others. "We do the whole gamut," she said.

With some of the same goals in mind, Dr. Joel Saper, a neurologist, founded the Michigan Head Pain and Neurological Institute in 1978 combining neurology, psychology, nursing, social work, anesthesiology, internal medicine, physical therapy and other services.

Treating pain is different from other specialties, Saper said, because it lacks an established hierarchy. For instance, for heart problems patients see cardiologists, or for brain surgery a neurosurgeon.

"Pain doesn't belong to one field," he said. "Anesthesiologists how have their own education curriculum, own knowledge base, own tools used to control pain. Physiatrists come from a different perspective of why a joint hurts or head hurts.